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Biomedical subjects

A Garg

Publications and source records attributed to A Garg.

At least 127 records · Page 7Linked to original sources
PubMed1995

Relationships of generalized and regional adiposity to insulin sensitivity in men.

The relative impacts of regional and generalized adiposity on insulin sensitivity have not been fully defined. Therefore, we investigated the relationship of insulin sensitivity (measured using hyperinsulinemic, euglycemic clamp technique with [3-3H]glucose turnover) to total body adiposity (determined by hydrodensitometry) and regional adiposity. The latter was assessed by determining subcutaneous abdominal, intraperitoneal, and retroperitoneal fat masses (using magnetic resonance imaging) and the sum of truncal and peripheral skinfold thicknesses. 39 healthy middle-aged men with a wide range of adiposity were studied. Overall, the intraperitoneal and retroperitoneal fat constituted only 11 and 7% of the total body fat. Glucose disposal rate (Rd) and residual hepatic glucose output (rHGO) values during the 40 mU/m2.min insulin infusion correlated significantly with total body fat (r = -0.61 and 0.50, respectively), subcutaneous abdominal fat (r = -0.62 and 0.50, respectively), sum of truncal skinfold thickness (r = -0.72 and 0.57, respectively), and intraperitoneal fat (r = -0.51 and 0.44, respectively) but not to retroperitoneal fat. After adjusting for total body fat, the Rd and rHGO values showed the highest correlation with the sum of truncal skinfold thickness (partial r = -0.40 and 0.33, respectively). We conclude that subcutaneous truncal fat plays a major role in obesity-related insulin resistance in men, whereas intraperitoneal fat and retroperitoneal fat have a lesser role.

Adipose Tissue↗
PubMed1994

Cholestyramine therapy for dyslipidemia in non-insulin-dependent diabetes mellitus. A short-term, double-blind, crossover trial.

OBJECTIVE: To assess clinical efficacy and tolerability of cholestyramine therapy in patients with dyslipidemia and non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: A randomized, double-blind, crossover study of cholestyramine (8 g twice daily) compared with placebo for a period of 6 weeks each. SETTING: Metabolic Unit and the Lipid and Diabetes Clinics at the Department of Veterans Affairs Medical Center, Dallas, Texas. PATIENTS: 21 patients with NIDDM that was well controlled using either glyburide or insulin therapy and with low-density lipoprotein (LDL) cholesterol levels more than 3.36 mmol/L (130 mg/dL) and fasting plasma triglyceride levels less than 3.4 mmol/L (300 mg/dL). MEASUREMENTS: During the last week of each period, for 5 consecutive days fasting plasma lipids and lipoproteins were measured, and plasma glucose levels were determined at 3, 7, and 11 a.m. and at 4 and 8 p.m. Daily urinary glucose excretion was measured for 3 days and glycosylated hemoglobin concentrations were determined on days 28 and 38 of the study periods. RESULTS: In this short-term study, when compared with placebo, cholestyramine reduced total cholesterol by 18% (95% CI, 14% to 22%) and LDL cholesterol by 28% (CI, 21% to 35%). Although cholestyramine therapy increased plasma triglyceride levels by 13.5% (CI, 1% to 26%), very-low density lipoprotein cholesterol and high-density lipoprotein cholesterol levels remained unchanged. Cholestyramine therapy improved glycemic control; mean plasma glucose values were lower by 13% (CI, 5% to 21%), a median reduction in urinary glucose excretion of 0.22 g/d was observed (P < 0.001), and a tendency to lower glycosylated hemoglobin concentration was noted. The doses of glyburide and insulin did not change during the study, and body weight remained stable. Constipation was the main side effect, and two patients dropped out of the study because of cholestyramine intolerance. CONCLUSIONS: In carefully selected male patients with NIDDM and high LDL cholesterol and normal triglyceride levels, cholestyramine therapy effectively reduces LDL levels and also may improve glycemic control. The long-term efficacy of cholestyramine therapy in patients with NIDDM needs further evaluation.

Adult↗
PubMed1994

Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To study effects of variation in carbohydrate content of diet on glycemia and plasma lipoproteins in patients with non-insulin-dependent diabetes mellitus (NIDDM). DESIGN: A four-center randomized crossover trial. SETTING: Outpatient and inpatient evaluation in metabolic units. PATIENTS: Forty-two NIDDM patients receiving glipizide therapy. INTERVENTIONS: A high-carbohydrate diet containing 55% of the total energy as carbohydrates and 30% as fats was compared with a high-monounsaturated-fat diet containing 40% carbohydrates and 45% fats. The amounts of saturated fats, polyunsaturated fats, cholesterol, sucrose, and protein were similar. The study diets, prepared in metabolic kitchens, were provided as the sole nutrients to subjects for 6 weeks each. To assess longer-term effects, a subgroup of 21 patients continued the diet they received second for an additional 8 weeks. MAIN OUTCOME MEASURES: Fasting plasma glucose, insulin, lipoproteins, and glycosylated hemoglobin concentrations. Twenty-four-hour profiles of glucose, insulin, and triglyceride levels. RESULTS: The site of study as well as the diet order did not affect the results. Compared with the high-monounsaturated-fat diet, the high-carbohydrate diet increased fasting plasma triglyceride levels and very low-density lipoprotein cholesterol levels by 24% (P < .0001) and 23% (P = .0001), respectively, and increased daylong plasma triglyceride, glucose, and insulin values by 10% (P = .03), 12% (P < .0001), and 9% (P = .02), respectively. Plasma total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels remained unchanged. The effects of both diets on plasma glucose, insulin, and triglyceride levels persisted for 14 weeks. CONCLUSIONS: In NIDDM patients, high-carbohydrate diets compared with high-monounsaturated-fat diets caused persistent deterioration of glycemic control and accentuation of hyperinsulinemia, as well as increased plasma triglyceride and very-low-density lipoprotein cholesterol levels, which may not be desirable.

Adult↗
PubMed1994

Garg replies.

Explore the source record for details and available documents.

Journal Article↗
PubMed1994

Reducing back stress through an ergonomic approach: weighing a patient.

Back problems are prevalent in nursing personnel. Nursing assistants in a nursing home stated weighing dependent patients was a very stressful task; they manually lifted patients up onto a chair scale. The task was redesigned in two ways: the use of a ramp scale and use of a hoist with a digital scale. With the new methods, perceived physical stress to shoulder, back and body was reduced, compressive force to L5S1 and shear force were reduced (wheelchair scale method), and "patient" feelings of comfort and security were increased.

Adult↗
PubMed1994

Counter-regulatory hormone responses to insulin-induced acute hypoglycemia in hypopituitary patients.

Patients with hypopituitarism are predisposed to fasting hypoglycemia and are considered unusually sensitive to insulin-induced acute hypoglycemia. However, whether impaired response of counter-regulatory hormones, such as glucagon, epinephrine (E), and nor-epinephrine (NE) contribute to the susceptibility to acute hypoglycemia in hypopituitary patients has not been systematically evaluated. Therefore, we compared counter-regulatory hormone responses to insulin-induced acute hypoglycemia in 9 patients with hypopituitarism who were off hormone replacement therapy and 13 normal healthy subjects. All subjects received aa prime-continuous intravenous infusion of insulin (0.1 Unit/kg body weight.h) till plasma glucose declined to less than 2.5 mmol/l or occurrence of hypoglycemic symptoms. All normal subjects and 7 out of 9 hypopituitary patients recovered spontaneously from hypoglycemia. Two hypopituitary patients with hypothalamic pathology however needed intravenous glucose, glucagon and hydrocortisone to assist recovery from hypoglycemia. Overall, patients with hypopituitarism showed a slower rate of recovery of plasma glucose after hypoglycemia than normal subjects (0.78 +/- 0.33 mmol/l.h vs. 1.72 +/- 0.15 mmol/l.h, respectively; p = 0.02). The responses of key counter-regulatory hormones, glucagon, E and NE, to hypoglycemia however were essentially similar in both the groups. We conclude that the lack of cortisol (secondary to ACTH deficiency) and GH in hypopituitary patients may be primarily responsible for the slow recovery of plasma glucose after acute hypoglycemia; and plasma glucagon, E, and NE responses are not impaired.

Acute Disease↗
PubMed1994

A comparison of isokinetic lifting strength with static strength and maximum acceptable weight with special reference to speed of lifting.

A laboratory study was conducted to determine the effects of the speed of lifting and box size on isokinetic strength and to compare isokinetic lifting strengths with static lifting strengths and psychophysically determined maximum acceptable weights. Nine male college students lifted three different boxes (250, 380 and 510 mm wide) from the floor to a bench height of 0.8 m using a free-style lifting technique at a rate of 0.2 lifts min-1. For each lifting task static strength was measured at the origin of lift. Isokinetic lifting strength was measured at 0.41, 0.51 and 0.6 ms-1 using a Biokinetic ergometer and attaching boxes to the load cell. Ratings of perceived exertion were recorded for the low back. There was a progressive decrease in mean and peak isokinetic lifting strengths both with an increase in lifting speed and with an increase in box width (p < 0.01). The lifting speed had a much greater effect (29% and 27%) than the box width (18% and 15%) on mean and peak isokinetic lifting strengths. However, high speed lifting was perceived subjectively to be less stressful (RPE = 10.7) than slow speed lifting (RPE = 12.7). Static strength and maximum acceptable weight had higher correlations with mean isokinetic strength (r = 0.65 and 0.82) than with peak isokinetic strength (r = 0.52 and 0.73). At 0.41 ms-1, mean isokinetic strength peak 6% greater than the mean static strength (p > or = 0.05). Extrapolation of mean isokinetic strength data showed that at 0.73 ms-1 the estimated mean isokinetic strengths were within 6% of maximum acceptable weights. It is concluded that isokinetic strength is highly dependent upon the speed of lifting. At a slow speed (0.41 ms-1), mean isokinetic strength is equal to mean static strength; and, at a high speed (0.73 ms-1), it appears to be equal to the maximum acceptable weight. It is recommended that both speed of lifting and box width should be controlled carefully to stimulate job-specific isokinetic lifting strength.

Adult↗
PubMed1994

Upper extremity disorders in a pork processing plant: relationships between job risk factors and morbidity.

Thirty-two jobs at a pork processing plant were semi-quantitatively analyzed in terms of their ergonomic characteristics, then classified as "hazardous" or "safe" in terms of potential risk for elbow or hand/wrist disorders. The spectrum, number, and incidence of such disorders occurring during the preceding 20 months were then compared to the job analyses and hazard classifications. There were 104 disorders associated with 15 job categories. The disorders included epicondylitis (24), nonspecific hand/wrist pain (41), carpal tunnel syndrome (CTS) (21), trigger finger (12), trigger thumb (3), and De-Quervain's tenosynovitis (3). The strength demands of the jobs associated with morbidity were significantly greater than those of jobs without morbidity. Differences in wrist posture were less significant. Type of grasp and repetitiveness were not significantly different. Practically all morbidity (96%) was associated with the hazardous job categories and occurred with a characteristic pattern of co-morbidity. The hazard classification scheme correctly predicted risk of upper extremity morbidity for 13 (87%) of the 15 job categories associated with morbidity and correctly predicted a lack of risk of morbidity for 16 (94%) of the 17 job categories not associated with morbidity. Significantly elevated relative risks were observed for any upper extremity disorder (11.4), any disorder excluding CTS (39.4), all specific disorders (6.9), and all specific disorders excluding CTS (19.4). The relative risk for CTS was 2.8 and not statistically significant. The results of this study provide additional epidemiological evidence that upper extremity musculotendinous disorders and some cases of CTS may be causally associated with work. The exertional demands of a task best explained the occurrence of morbidity.

Arm↗
PubMed1994

Management of dyslipidemia in IDDM patients.

Patients with insulin-dependent diabetes mellitus (IDDM) are at an increased risk for coronary heart disease. Factors that may enhance the risk include dyslipidemia, hypertension, and hyperglycemia. Until recently, the importance of dyslipidemia in IDDM was ignored because the prevalence of high cholesterol levels was similar to that in the nondiabetic population. However, unique abnormalities in the composition and metabolism of lipoproteins may occur in IDDM patients. Management of IDDM patients, therefore, should include control of dyslipidemia as well as control of hyperglycemia and hypertension. The therapeutic goals for serum cholesterol reduction in IDDM patients should be lower than that for nondiabetic patients, and the goals for children should be even lower than those for adults. Both very-low-density lipoprotein and low-density lipoprotein (LDL) levels should be the targets for therapeutic interventions and not just the LDL alone. Because of the unique features of dyslipidemia in IDDM patients, the therapeutic options may not be the same as that for nondiabetic patients. Hyperglycemia should be controlled by matching daily energy intake and activity with appropriately timed doses of insulin. The diets should be low in saturated fats and cholesterol. If dyslipidemia persists despite diet and hyperglycemia management, drug therapy may be initiated. For IDDM children > or = 10 years of age with elevated LDL-cholesterol levels, the first-line therapy should be bile acid sequestrants. For adults with IDDM, bile acid sequestrants also may be the drugs of choice, particularly for normotriglyceridemic patients. Nicotinic acid therapy should be avoided. Among other drugs, hydroxymethyl-glutaryl coenzyme A reductase inhibitors may be preferable for patients with elevated LDL cholesterol and borderline hypertriglyceridemia. Fibric acid derivatives should be used for markedly hypertriglyceridemic patients. The role of probucol for dyslipidemia in IDDM patients is not clear.

Blood Glucose↗
PubMed1994

Norms for renal parenchymal volume in Indian children.

Seventy-seven clinically normal children with kidneys of normal size were examined sonographically. Renal parenchymal volumes were calculated and related to age, height, body weight and body surface area; growth charts were constructed. A significant correlation was found between the renal parenchymal volume and the body somatometric parameters. The present report thus provides norms for renal parenchymal volume in Indian children.

Anthropometry↗
PubMed1994

An outbreak of influenza A (H3N2) in Delhi, 1993.

An outbreak of Influenza A, subtype H3N2 occurred in Delhi during July-August, 1993. Both urban and rural areas were affected. Attack rates in children and adults were found to be similar; the mean age of patients from whom the virus was isolated was found to be 21 years. The disease was of acute onset, mild in nature and about one week in duration. Main symptoms included fever, chills, cough, sore throat, bodyaches, backache and headache. Complications were absent. About 82 per cent of the affected house-holds had only a single case. Influenza A subtype H3N2 virus was isolated from 12 of 15 throat swabs collected from PUO cases.

Adolescent↗
PubMed1994

Estimation of adipose tissue mass by magnetic resonance imaging: validation against dissection in human cadavers.

The evaluation of adipose tissue distribution has become an essential component of investigations on the complications of obesity. However, a major limitation is lack of methodology for accurate estimation of adipose tissue mass in the different regions of the body. Therefore, we have tested the accuracy and precision of magnetic resonance imaging (MRI) as a method to measure adipose tissue mass in regions of the body not accessible with standard anthropometric methods. The mass of subcutaneous and intraabdominal adipose tissue estimated by MRI was compared with that obtained by direct weighing of the same adipose tissue compartments after dissection in human cadavers. MRI was performed on three unembalmed cadavers (two males, one female) who were subsequently dissected to isolate intraperitoneal, retroperitoneal, and subcutaneous adipose tissues. These same components were delineated by MRI. The results of the two methods were highly congruent. For the various compartments, the mean of the difference between the two methods was only 0.076 kg (95% confidence interval + 0.005 kg and + 0.147 kg). The "limits of agreement" between the two techniques were -0.066 kg and +0.218 kg. Multiple repeated estimates of mass of adipose tissue compartments were made to determine reproducibility of the MRI measurement; the coefficient of variation for repeated measures was below 14%. The results of this study show that MRI is an accurate and precise technique to evaluate adipose tissue mass in subcutaneous and intraabdominal compartments. Furthermore, MRI was found to be a valid method to separately evaluate the mass of intraabdominal subcompartments of intraperitoneal and retroperitoneal adipose tissue.

Abdomen↗